Urinary bladder retroversion and neourethrocystostomy for treatment of inadvertent prostatectomy and urethrectomy in a dog

Abstract

CASE DESCRIPTION A 15-month-old male Newfoundland was examined because of an inability to urinate, lethargy, inappetence, and intermittent vomiting that first became evident after bilateral cryptorchidectomy 2 days previously. The patient was referred for further evaluation and treatment. CLINICAL FINDINGS Results of physical examination, serum biochemical analysis, and abdominocentesis led to a diagnosis of uroperitoneum. Retrograde cystography indicated urinary tract obstruction. In view of the history of recent elective cryptorchidectomy, a diagnosis of uroperitoneum with urethral obstruction secondary to iatrogenic prostatectomy and urethrectomy was made. TREATMENT AND OUTCOME During a ventral midline celiotomy, the inadvertent prostatectomy and urethrectomy were found to have resulted in insufficient urethral length for primary repair. Surgical repair of the urethral defect was achieved by means of a novel technique of bladder retroversion and neourethrocystostomy at the apex of the bladder. A urethral stricture evident 1.5 months after surgery was initially treated with balloon dilatation, followed by temporary and then permanent placement of a self-expanding metallic stent. At the last follow-up 6.6 years after stent placement, the dog remained continent while receiving phenylpropanolamine and the owner was highly satisfied with the outcome. CLINICAL RELEVANCE Caudal intraabdominal bladder retroversion with apex neourethrocystostomy may be a viable alternative to more complex urethral lengthening procedures in dogs and can potentially preserve lower urinary tract function. This treatment might be considered for patients with urethral trauma or malignant neoplasia necessitating extensive urethral resection. Urethral strictures may be effectively managed with stenting.

Inadvertent iatrogenic prostatectomy and urethrectomy in 2 dogs

“…In this case report both dogs were intact male small breed dogs with a body weight of less than 10 kg and an age of 8 years and 9 years respectively. Inadvertent iatrogenic prostatectomy in dogs has been reported after cryptorchidectomy [10][33] and bilateral perineal herniorrhaphy with resection of a presumed paraprostatic cyst [34]. In both presented patients the prostate and distinct parts of the urethra were inadvertently removed because of mistakenly identifying the prostate as neoplastic tissue in the ischiorectal fossa.…”

“…Retrograde urethrography with instillation of a positive contrast medium into the urethra helped in both cases to identify urethral ligation or perforation. Urethrography remains the imaging modality of choice to evaluate the entire organ [10] [27]. In the first patient the histopathologic examination of the prostate revealed an adenocarcinoma.…”

“…Because of its limited indication, as small tumours are strictly confined to the prostatic parenchyma [23], total prostatectomies are rarely performed [11] [41]. Inadvertent iatrogenic prostatectomy and urethrectomy is a rarely described complication after perineal herniorrhaphy [34] and cryptorchidectomy [10] [33]. Inadvertent prostatectomy may cause urethral obstruction and inevitably leads to an inability to urinate, with life-threatening consequences [10][33] [34].…”

“…Inadvertent iatrogenic prostatectomy and urethrectomy is a rarely described complication after perineal herniorrhaphy [34] and cryptorchidectomy [10] [33]. Inadvertent prostatectomy may cause urethral obstruction and inevitably leads to an inability to urinate, with life-threatening consequences [10][33] [34]. This case report describes 2 dogs that were…”

Viabilidade da técnica de transposição uretral pré-púbica mediante secção peniana em cadáveres de cães

“…Poucas técnicas reconstrutivas da uretra do cão são mencionadas e incluem enxertos autólogos de mucosa oral (Paulo et al, 2004), fáscia lata (Atalan et al, 2005), carótida conservada (Paulo et al, 2000) e stents vasculares (Flesher et al, 2016), entretanto, embora sejam de fácil execução, segundo os autores , as complicações, a exigência de dois tempos cirúrgicos, o custo elevado e a disponibilidade dos implantes, muitas vezes, inviabilizam o uso destes; em contrapartida, a TUPP é realizada em apenas um tempo cirúrgico, não requer implantes e doadores e disponibiliza tecido uretral suficiente para permitir anastomose sem tensão na sutura. Recentemente, duas técnicas semelhantes à TUPP foram relatadas para cães, propondo-se a secção peniana em região escrotal com desvio uretral cranialmente ao púbis para anastomose extra pélvica, dando continuidade ao fluxo urinário.…”